Congress Abstracts 2004

5

IMPROVING CHEMOTHERAPY ADMINISTRATION TURN AROUND TIME IN THE INPATIENT SETTING. Joanne Dobry, RN, BSN, OCN^®, Patti Wilcox, APN, MSN, AOCN^®, and Anna Gray, RN, BSN, CBON, Sinai Hospital of Baltimore, Baltimore, MD.

As part of a performance improvement initiative, the staff completed audits of inpatient chemotherapy administration turn-around time (TAT). TAT was defined as time of admission to initiation of chemotherapy. A three-hour TAT was the goal.

Due to staff nurse observations and patient complaints, as well as physician dissatisfaction of increasing delays of chemotherapy administration, a performance improvement initiative was developed. This initiative studied the turn-around time of inpatient chemotherapy administration. It was anticipated that the oncology population would increase with the addition of two medical oncologists.

An audit tool, completed by staff, was developed to track TAT of chemotherapy administration. Quantitative data was collected. Following two months of data collection, a multidisciplinary team consisting of an advanced practice nurse, nurse practitioner, clinical leader, pharmacist, unit manager, and medical oncologist was created. This team met to discuss and implement changes based on the data. Subsequent audit revisions incorporated qualitative data from staff. Staff education occurred, and process changes were implemented at intervals. Staffing assignments were modified to accommodate chemotherapy admissions. Data collection continues.

The audit began in December 2002. Initial data was as follows: (December 2002) N = 5, TAT = 5.13 hours. The revised audit tool included anecdotal evidence of time delay. This information permitted the inpatient unit to make process changes recommended by the multidisciplinary team. In July 2003, N = 17, TAT = 7.02. Results demonstrated a 200% increase in volume, with a 29% increase in TAT.

Through qualitative and quantitative evidence, the process of chemotherapy administration was adjusted. The TAT target is now set at four hours, with data collection continuing. Collaboration between all disciplines continues, with additional anecdotal evidence supporting increased satisfaction from patients, staff, and physicians.